Patients with diabetes and receiving MTMC had greater A1C improvements, compared with controls, of 0.54% (P = 0.0067) at 6 months and 0.63% (P = 0.0160) at 12 months. At 6 months, SBP and DBP decreased in MTMC patients by 6.5 mm Hg (P = 0.0108) and 3.8 mm Hg (P = 0.0136) more than controls, respectively. At 12 months, those receiving MTMC services had SBP and DBP decreases, respectively, of 8.2 mm Hg (P = 0.0018) and 1.7 mm Hg (P = 0.2691) compared with controls. ED and hospital visits were not statistically significantly different between groups. Conclusion and Relevance: This MTMC potentially improved outcomes for referred patients in whom target goals were difficult to achieve and can serve as a model for other similar medication management programs.
Introduction
Left atrial (LA) tissue characteristics may play an important role in atrial fibrillation (AF) induction and perpetuation. Although frequently used in clinical practice, computed tomography (CT) has not been employed to describe differences in LA wall properties between AF patients and controls. We sought to noninvasively characterize AF associated differences in LA tissue using CT.
Methods
CT images of the LA were obtained in 98 consecutive patients undergoing AF ablation and in 89 controls. A custom software algorithm was used to measure wall thickness and density in four pre-specified regions of the LA.
Results
On average, LA walls were thinner (−15.5%, 95% confidence interval [CI] −23.2 to −7.8%, p <0.001) and demonstrated significantly lower density (−19.7 Hounsfield Units [HU], 95% CI −27.0 to −12.5 HU, p <0.001) in AF patients compared to controls. In linear mixed models adjusting for demographics, clinical variables, and other CT measurements, the average LA, interatrial septum, left atrial appendage, and anterior walls remained significantly thinner in AF patients. After adjusting for the same potential confounders, history of AF was associated with reduced density in the LA anterior wall and increased density below the right inferior pulmonary vein and in the left atrial appendage.
Conclusion
Application of an automated measurement algorithm to CT imaging of the atrium identified significant thinning of the LA wall and regional alterations in tissue density in patients with a history of AF. These findings suggest differences in LA tissue composition can be noninvasively identified and quantified using CT.
ObjectiveTo determine the overall perception and utilization of the pharmacist managed
medication therapy management (MTM) clinic services, by healthcare
professionals in a large, urban, university medical care setting.MethodsThis was a cross-sectional, anonymous survey sent to 195 healthcare
professionals, including physicians, nurses, and pharmacists at The
University of Illinois Outpatient Care Center to determine their perception
and utilization of the MTM clinic. The survey consisted of 12 questions and
was delivered through a secure online application.ResultsSixty-two healthcare professionals (32%) completed the survey. 82% were
familiar with the MTM clinic, and 63% had referred patients to the clinic.
Medication adherence and disease state management was the most common reason
for referral. Lack of knowledge on the appropriate referral procedure was
the prominent reason for not referring patients to the MTM clinic. Of the
providers that were aware of MTM services, 44% rated care as ‘excellent’,
44% as ‘good’, 5% as ‘fair’, and 0% stated ‘poor’. Strengths of MTM clinic
identified by healthcare providers included in-depth education to patients,
close follow-up, and detailed medication reconciliation provided by MTM
clinic pharmacists. Of those familiar with MTM clinic, recommendations
included; increase marketing efforts to raise awareness of the MTM clinic
service, create collaborative practice agreements between MTM pharmacists
and physicians, and ensure that progress notes are more concise.ConclusionsIn a large, urban, academic institution MTM clinic is perceived as a valuable
resource to optimize patient care by providing patients with in-depth
education as it relates to their prescribed medications and disease states.
These identified benefits of MTM clinic lead to frequent patient referrals
specifically for aid with medication adherence and disease state
management.
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